乙状窦后入路显微手术治疗小脑桥脑角肿瘤继发三叉神经痛

Removing Cerebellopontine Angle Tumor Via an Retrosigmoid Approach and Lessening Secondary Trigeminal Neuralgia

目的：探讨乙状窦后入路显微手术治疗小脑桥脑角肿瘤继发三叉神经痛的临床疗效。方法：采用耳后小切口乙状窦后入路切除术治疗继发三叉神经痛的小脑桥脑角肿瘤10例，其中胆脂瘤7例，脑膜瘤3例。手术中发现肿瘤直接包绕三叉神经6例；肿瘤将三叉神经压向后下方3例；另1例肿瘤与三叉神经无明显关联，但脑干移位造成小脑上动脉压迫三叉神经。结果：7例胆脂瘤患者中4例全切除、3例大部切除，3例脑膜瘤患者均取得全切除。手术后10例中9例三叉神经痛停止发作，1例患者疼痛减轻，服用卡马西平后症状得到较好控制。随访6～13个月无三叉神经痛复发病例。结论：采用经乙状窦后入路显微手术切除小脑桥脑角肿瘤，同时探查肿瘤与三叉神经的关系，必要时行微血管减压术，可明显改善患者继发性三叉神经痛症状，有良好的手术疗效。

Objective：To explore clinical effects of removing cerebellopontine angle tumor （CAT） via a retrosigmoid approach for relieving secondary trigeminal neuralgia （ STN ）. Methods： Ten CAT, including 7 cholesteatomas and 3 meningeomas, were removed via a retrosigmoid approach through a little incision in retroauricular region. During the operations, it was found that the trigeminal nerve （ NV ） was directly encased by tunor in 6 cases, the NV was oppressed backwards by the tumors in 3 cases, the NV was oppressed by the superior cerebellar artery resulted from brainstem shifting, and no relationship between the tumor and the NV was observed in one case. Results ： Four of 7 eholesteatomas and 3 meningeoma obtained total resection ; other 3 cholesteatomas got subtotal resection. After operation, neuralgia disappeared in 9 cases and relieved in＇ one. Nobody complained neuralgia recurring during the follow - up period of 6 - 3 mouths. Conclusions ： Removing CAT via a retrosigmoid approach, at the same time, exploring the relationship between the tumors and NV, doing microvaeular decompression pro re nata, could obviously relieve the symptom of STN, presents a good operational effect.